Disrupting the Status Quo in Late Diagnosis of Breast Cancers in the Resource Limited Settings
Main Article Content
Abstract
Breast cancer tops the list of female cancers both in incidence and mortality. Eastern and south Asian countries have seen a very significant 86%-89% rise in age standardized incidence. Currently 5-year survival of breast cancer in low- and middle-income countries is only 40-60%. There is an urgent need to reduce delays in diagnosis of breast cancer and establish effective referral pathways to improve the observed low survival. Existing literature describes reasons for such delays in breast cancer management extensively, yet does not propose solutions to disrupt this status quo.
Pre-diagnostic delays and diagnostic delays are interdependent due to overlapping socioeconomic and cultural barriers to seeking health, and accessing and accepting care. Non-availability of diagnostic tests or trained human resource and out of pocket expenditure complicate these delays. Present article highlights probable solutions to mitigate these problems with an emphasis on resource limited settings.
Early diagnosis of breast cancer essentially involves reducing the delays in triple assessment of symptomatic patients in the context of limited resources. Clinical breast examination, use of ultrasonography and fine needle aspiration biopsy which are possible to organize at secondary level can mitigate some of the delays. Newer technologies like portable ultrasound devices, use of artificial intelligence, cartridge based real time receptor assay can further reduce the diagnostic delay. Many pilot studies and interventions using newer point of care tests are in progress to establish their role against gold standard investigations in clinical practice.
Delay in diagnosis cannot be mitigated by providing standalone solutions. Robust pathways with provision of green corridor for referrals, task shifting of patient navigation to various grassroot level health care workers, developing contextual practice guidelines, recognising challenges and weaknesses of cancer control system, and realizing importance of equitable distribution of health resources can strengthen the cancer control strategies and mitigate the delays in breast cancer diagnosis.
Keywords:
Breast Cancers, Late Diagnosis of Breast Cancers
Article Details
How to Cite
GADGIL, Anita et al.
Disrupting the Status Quo in Late Diagnosis of Breast Cancers in the Resource Limited Settings.
Medical Research Archives, [S.l.], v. 11, n. 11, nov. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/4627>. Date accessed: 16 may 2024.
doi: https://doi.org/10.18103/mra.v11i11.4627.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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12. Devi BC, Tang TS, Corbex M. Reducing by half the percentage of late-stage presentation for breast and cervix cancer over 4 years: a pilot study of clinical downstaging in Sarawak, Malaysia. Ann Oncol. 2007 Jul;18(7):1172-6. doi: 10.1093/annonc/ mdm105.
13. Pak LM, Purad CC, Nadipally S, Rao MP, Mukherjee S, Hegde SKB, Golshan M. Cancer Awareness and Stigma in Rural Assam India: Baseline Survey of the Detect Early and Save Her/Him (DESH) Program. Ann Surg Oncol. 2021 Nov; 28(12):7006-7013. doi: 10.1245/ s10434-021-10366-7.
14. Ezeome ER, Anarado AN. Use of complementary and alternative medicine by cancer patients at the University of Nigeria Teaching Hospital, Enugu, Nigeria. BMC Complement Altern Med. 2007 Sep 12;7:28. doi: 10.1186/1472-6882-7-28.
15. Homsy J, King R, Balaba D, Kabatesi D. Traditional health practitioners are key to scaling up comprehensive care for HIV/AIDS in sub-Saharan Africa. AIDS. 2004 Aug 20;18(12):1723-5. doi: 10.1097/01.aids.0000 131380.30479.16.
16. Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health. 2014; 35:399-421. doi: 10.1146/annurev-publhealth -032013-182354.
17. Basu P, Selmouni F, Belakhel L, Sauvaget C, Abousselham L, Lucas E, Muwonge R, Sankaranarayanan R, Khazraji YC. Breast Cancer Screening Program in Morocco: Status of implementation, organization and performance. Int J Cancer. 2018 Dec 15; 143(12):3273-3280. doi: 10.1002/ijc.31749.
18. IARC. Breast Cancer Screening. IARC Handbooks of Cancer Prevention Volume 15. Lyon: International Agency for Research on Cancer; 2016
19. Ramadas K, Basu P, Mathew BS, Muwonge R, Venugopal M, Prakasan AM, Malu R, Lucas E, Augustine P, Mony RP, Thara S, Sankaranarayanan R. Effectiveness of triennial screening with clinical breast examination: 14-years follow-up outcomes of randomized clinical trial in Trivandrum, India. Cancer. 2023 Jan 15; 129(2):272-282. doi: 10.1002/cncr.34526.
20. Joshi R, Alim M, Kengne AP, Jan S, Maulik PK, Peiris D, Patel AA. Task shifting for non-communicable disease management in low and middle income countries--a systematic review. PLoS One. 2014 Aug 14;9(8):e103754. doi: 10.1371/journal.pone. 0103754.
21. Goodson WH 3rd, Moore DH 2nd. Overall clinical breast examination as a factor in delayed diagnosis of breast cancer. Arch Surg. 2002 Oct; 137(10):1152-6. doi: 10.1001 /archsurg.137.10.1152.
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